Healthcare Provider Details

I. General information

NPI: 1508303934
Provider Name (Legal Business Name): KRISTINA MARIE FLESHER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 HAYES AVE
SANDUSKY OH
44870-4737
US

IV. Provider business mailing address

13711 RILEY RD
MILAN OH
44846-9485
US

V. Phone/Fax

Practice location:
  • Phone: 419-557-5177
  • Fax:
Mailing address:
  • Phone: 419-557-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1601184
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: